scholarly journals Antimicrobial stewardship strategies in wound care: evidence to support the use of dialkylcarbamoyl chloride (DACC)- coated wound dressings

2021 ◽  
Vol 30 (4) ◽  
pp. 284-296
Author(s):  
Mark G Rippon ◽  
Alan A Rogers ◽  
Karen Ousey
Keyword(s):  
Wound Infection ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Wound Care ◽  
The Body ◽  
Wound Dressings ◽  
Wound Management ◽  
Resistant Bacteria ◽  
Treatment Regimens ◽  
Bacterial Binding

Background: Traditionally, infections are treated with antimicrobials (for example, antibiotics, antiseptics, etc), but antimicrobial resistance (AMR) has become one of the most serious health threats of the 21st century (before the emergence of COVID-19). Wounds can be a source of infection by allowing unconstrained entry of microorganisms into the body, including antimicrobial-resistant bacteria. The development of new antimicrobials (particularly antibiotics) is not keeping pace with the evolution of resistant microorganisms and novel ways of addressing this problem are urgently required. One such initiative has been the development of antimicrobial stewardship (AMS) programmes, which educate healthcare workers, and control the prescribing and targeting of antimicrobials to reduce the likelihood of AMR. Of great importance has been the European Wound Management Association (EWMA) in supporting AMS by providing practical recommendations for optimising antimicrobial therapy for the treatment of wound infection. The use of wound dressings that use a physical sequestration and retention approach rather than antimicrobial agents to reduce bacterial burden offers a novel approach that supports AMS. Bacterial-binding by dressings and their physical removal, rather than active killing, minimises their damage and hence prevents the release of damaging endotoxins. Aim: Our objective is to highlight AMS for the promotion of the judicious use of antimicrobials and to investigate how dialkylcarbamoyl chloride (DACC)-coated dressings can support AMS goals. Method: MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify published articles describing data relating to AMS, and the use of a variety of wound dressings in the prevention and/or treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent and/or treat wound infection in a manner that does not kill or damage the microorganisms (for example, by actively binding and removing intact microorganisms from wounds) were then narratively reviewed. Results: The evidence reviewed here demonstrates that using bacterial-binding wound dressings that act in a physical manner (for example, DACC-coated dressings) as an alternative approach to preventing and/or treating infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS. Conclusion: Some wound dressings work via a mechanism that promotes the binding and physical uptake, sequestration and removal of intact microorganisms from the wound bed (for example, a wound dressing that uses DACC technology to successfully prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS (for example, reducing the use of antimicrobials in wound treatment regimens) by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.

Skin problems in palliative care

2021 ◽  
pp. 613-621
Author(s):  
Sebastian Probst ◽  
Georgina Gethin
Keyword(s):  
Palliative Care ◽  
Wound Care ◽  
Skin Care ◽  
Wound Dressings ◽  
Wound Management ◽  
Care Needs ◽  
Skin Breakdown ◽  
Local Problems ◽  
Self Worth ◽  
Skin Conditions

Nursing aspects of palliative wound care are driven by patient and family goals integrated with three components of wound management: the management or palliation of the underlying cause of the wound, management of wound-related symptoms, and management of the wound and peri-wound skin. Wounds most commonly encountered include pressure ulcers, fungating malignant wounds, and fistulae. Patients with blistering skin conditions, inherited and acquired, have extensive long-standing wounds and palliative care needs. In addition, meticulous skin care for patients of all ages with debilitating long-term conditions is crucial to prevent unnecessary skin breakdown. The symptoms and local problems associated with broken skin and wounds include odour, exudate, excoriation, maceration, bleeding, pain, and pruritus. Key clinical interventions include the application of wound dressings and skin care products. Unless these are managed effectively and consistently, body image and feelings of self-worth are affected together with the ability to socialize and maintain function, including, for some people, employment.

scholarly journals Certain Aspects of Silver and Silver Nanoparticles in Wound Care: A Minireview

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Marek Konop ◽  
Tatsiana Damps ◽  
Aleksandra Misicka ◽  
Lidia Rudnicka
Keyword(s):  
Silver Nanoparticles ◽  
Clinical Practice ◽  
Pathogenic Bacteria ◽  
Antimicrobial Agents ◽  
Antifungal Agents ◽  
Wound Care ◽  
Wound Dressings ◽  
Major Health Problem ◽  
Major Health ◽  
Bactericidal Effects

Resistance to antimicrobial agents by pathogenic bacteria has emerged in recent years and is a major health problem. In this context silver and silver nanoparticles (AgNP) have been known to have inhibitory and bactericidal effects and was used throughout history for treatment of skin ulcer, bone fracture, and supporting wound healing. In all of these applications prevention and treatment of bacterial colonized/infected wounds are critical. In this context silver and its derivatives play an important role in health care. Silver is widely used in clinical practice in the form of silver nitrate and/or silver sulfadiazine. In the last few years silver nanoparticles entered into clinical practice as both antimicrobial and antifungal agents. In addition, nanosilver is used in coating medical devices (catheters) and as component of wound dressings. In this paper we present summarized information about silver and nanoparticles made of silver in the context of their useful properties, especially antibacterial ones, being of a great interest for researchers and clinicians.

Skin problems in palliative care

2015 ◽  
Author(s):  
Patricia Grocott ◽  
Georgina Gethin ◽  
Sebastian Probst
Keyword(s):  
Palliative Care ◽  
Wound Care ◽  
Skin Care ◽  
Wound Dressings ◽  
Wound Management ◽  
Care Needs ◽  
Long Term Conditions ◽  
Local Problems ◽  
Self Worth ◽  
Skin Conditions

Nursing aspects of palliative wound care are driven by patient and family goals integrated with three components of wound management: the management or palliation of the underlying cause of the wound, management of wound-related symptoms, and management of the wound and peri-wound skin. Wounds most commonly found include pressure ulcers, fungating malignant wounds, and fistulae. Patients with blistering skin conditions, inherited and acquired, have extensive longstanding wounds and palliative care needs. In addition, meticulous skin care for patients of all ages with debilitating long-term conditions is crucial to prevent unnecessary skin breakdown. The symptoms and local problems associated with broken skin and wounds include odour, exudate, excoriation, maceration, bleeding, pain, and pruritus, and key clinical interventions include the application of wound dressings and skin care products. Unless these are managed effectively and consistently, body image and feelings of self-worth are affected together with the ability to socialize and maintain employment.

scholarly journals Study of hydrocellular functional material as microbicidal wound dressing for diabetic wound healing

2021 ◽  
Vol 19 ◽  
pp. 228080002110549
Author(s):  
Michael Rodrigues ◽  
Thilagavati Govindharajan
Keyword(s):  
Wound Healing ◽  
Wound Dressing ◽  
Wound Care ◽  
Cost Effective ◽  
Wound Dressings ◽  
Wound Management ◽  
Histopathological Analysis ◽  
Diabetic Wound ◽  
Functional Material ◽  
Diabetic Wound Healing

A hydrocellular functional material as a wound dressing is developed and it is found to be superior in its efficacy as compared to some of the comparator controls in diabetic wound healing studies. A study on wound contraction and Histopathological analysis is done in rats. The efficacy of the dressing is comparable to the established wound dressings like Carboxymethyl cellulose alginate dressings and autolytic enzyme based hydrogel. It is found to be superior to Polyhexamethylene biguanide dressing used as reference controls in this study. The reason for good wound healing performance of the dressing can be attributed to a combined property of effective exudates management and broad spectrum antimicrobial effect. The concept of functional hydro cellular material has shown good results due to the excellent balance of exudates pickup and drying it out. This ensures moist wound healing conditions on the wound. Because of its porous nature it allows good air flow and gaseous exchange in the structure. The cationic sites created on the surface of the dressing ensure a good antimicrobial action on the exudates in the dressing. It reduces the infection load on the wound. The nonleaching property of the dressing also helps in preventing the generation of more resistant and mutant strains of the microbes. The developed dressing can be used as a relatively durable long lasting dressing for wound management in diabetic wounds. The need of repetitive wound dressing changes can be brought down with this concept of dressing. It is not only cost effective in terms of its material cost but also is a cost effective solution when entire wound management cost is considered. Such novel wound dressing material can change the quality of life of diabetic wound patients especially in developing world, where access to functional advanced wound care dressings is limited.

scholarly journals Modern approaches to treatment of superficial dermal burns

2020 ◽  
pp. 40-41
Author(s):  
O.M. Kovalenko ◽  
A.O. Kovalenko ◽  
O.I. Оsadcha ◽  
O.M. Lynnyk
Keyword(s):  
Comparison Group ◽  
Main Group ◽  
The Body ◽  
Water Soluble ◽  
Wound Dressings ◽  
Wound Management ◽  
Quantitative Composition ◽  
Closed Chamber ◽  
Microbial Association ◽  
Healing Wound

Objective. The aim of the study is improving the treatment’s effectiveness in patients with superficial dermal burns due to the usage of modern wound dressings. Materials and methods. Under observation were 150 patients with superficial dermal thermal lesions with an area of 5-30 % of the body surface aged 10-64 years, who were treated at the Kyiv City Clinical Hospital № 2 during 2016-2019. The main group consisted of 120 patients, whose burn’s treatment provided under wound dressings in a humid environment (hydrogel, spongy polyurethane foam, film coatings). Comparison group – 30 patients whose wounds were treated by applying wet-drying bandages or bandages with water-soluble antibacterial ointments. Results and discussion. At the beginning of the treatment, the pH of the wound content of dermal burns was 7.9-8.1. On the 3rd day of treatment in patients of the main group, the pH of wounds under wound dressings was defined as acidic (5.7). In patients of the comparison group on the 3rd and 4th day the pH of the wounds was determined as alkaline, and only on the 6th day it became slightly acidic. As the pH of the wounds increased, the rate of healing decreased. In the phase of acute inflammation and exudation, the pH of superficial dermal burns was alkaline 7.8-8.2, in the proliferation phase, under the wound coverings – acidic (5.5-4.1). The use of wound dressings led to a decrease in the number of microbial association in patients to 1.1±0.4 on 9-11th days after injury, the colonization of wound surfaces changed slightly to 3×102 per 1 g. In contrast, in patients of the comparison group in the sequestration period of superficial necrotic scab increased the number of microbial associates to 2.8±0.7, wound colonization increased to 105 per 1 g of tissue. The time of epithelialization with the use of wound dressings was 13.8±1.7 days, in patients of another group – 19.4±2.5 days. Conclusions. Wound dressings that keep the wound moist are an effective way to influence the wound process, which can be regulated. In the treatment of superficial dermal burns under wound dressings there is a change of the alkaline reaction to acidy, which stimulates wound healing. Wound management in a wet closed chamber changes the qualitative and quantitative composition of the wound microflora, reduces the microbial contamination of burn wounds by two orders of magnitude. Superficial dermal burns heal under wound dressings for 13.8 days against 19.4 in traditional treatment.

Antibacterial Strategies for Wound Dressing: Preventing Infection and Stimulating Healing

2018 ◽  
Vol 24 (8) ◽  
pp. 936-951 ◽  
Author(s):  
Zhengwen Li ◽  
Menno Knetsch
Keyword(s):  
Wound Infection ◽  
Wound Dressing ◽  
Antibacterial Agents ◽  
Controlled Drug Release ◽  
Research Direction ◽  
Infection Process ◽  
Wound Dressings ◽  
Wound Management ◽  
Global Issue ◽  
Insight Into

Wound management is an important and increasing global issue. Infection of a wound can cause a delay in wound healing and pain, but also more serious complications like tissue necrosis or even sepsis, which can lead to loss of tissue, limbs or life. Antibacterial agents have been introduced into wound infection care. In this review, we provide an insight into the current antibacterial strategies of wound dressings, including wound infection process, antibacterial agents, and controlled drug release systems. We also emphasize the development of intelligent wound dressing and introduce a promising research direction.

Antimicrobial stewardship in wound care

2020 ◽  
Vol 29 (15) ◽  
pp. S10-S16
Author(s):  
Val Edwards-Jones
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Wound Care ◽  
Advisory Committees ◽  
Healthcare Facilities ◽  
Full Compliance ◽  
National Guidance ◽  
New Antibiotics ◽  
Underlying Causes ◽  
The Impact

Strategies to tackle the global crisis of antimicrobial resistance include implementing antimicrobial stewardship across the healthcare and agricultural sectors. Many clinical specialities have developed policies to advise practitioners on how to prescribe antibiotics more effectively, but there is still a lack of data on the impact of this change. Overuse and misuse of antibiotics have been commonplace since their introduction 70 years ago, and have contributed to the development of the resistance seen today. There is a dearth of new antibiotics and, if nothing is done to restrict the use of those that remain effective, there is a risk of returning to the pre-antibiotic era where simple infections could result in death. In wound care, it is essential that antibiotic treatment is appropriate to reduce infections. Many medical conditions predispose people to wounds that are difficult to heal and become chronic unless the underlying causes are addressed. Most wound infections are caused by bacteria, which are becoming increasingly resistant to commonly used antibiotics. This necessitates strict regimens for managing infection, which include prescribing antibiotics only when they are essential. Antimicrobial stewardship is undertaken in all UK healthcare facilities, and local advisory committees oversee the prudent use of antibiotics and other antimicrobial agents to try to prevent further increases in resistance. National guidance has been produced but whether full compliance has been followed has yet to be established and the impact of implementation needs to be analysed.

scholarly journals Antimicrobial Silver Nanoparticles for Wound Healing Application: Progress and Future Trends

Materials ◽  
2019 ◽  
Vol 12 (16) ◽  
pp. 2540 ◽  
Author(s):  
Federica Paladini ◽  
Mauro Pollini
Keyword(s):  
Wound Healing ◽  
Silver Nanoparticles ◽  
Antimicrobial Agents ◽  
Healing Process ◽  
Wound Management ◽  
Resistant Bacteria ◽  
Wound Healing Process ◽  
Diabetic Patients ◽  
Special Focus ◽  
European Economic Area

Recent data have reported that the burden of infections related to antibiotic-resistant bacteria in the European Union and European Economic Area (EEA) can be estimated as the cumulative burden of tuberculosis, influenza, and human immunodeficiency virus (HIV). In wound management, the control of infections represents a crucial issue and a multi-billion dollar industry worldwide. For diabetic wounds ulcers, in particular, infections are related to the majority of amputations in diabetic patients, which today represent an increasing number of the elderly. The greatest barrier to healing is represented by the biofilm, an organized consortium of bacteria encapsulated in a self-produced extracellular polymeric substance with high resistance to conventional antimicrobial therapies. There is an urgent need for novel anti-biofilm strategies and novel antimicrobial agents and, in this scenario, silver nanotechnology has received tremendous attention in recent years in therapeutically enhanced healthcare. Due to its intrinsic therapeutic properties and the broad-spectrum antimicrobial efficacy, silver nanoparticles have opened new horizons towards novel approaches in the control of infections in wound healing. This review aims at providing the reader with an overview of the most recent progress in silver nanotechnology, with a special focus on the role of silver in the wound healing process.

scholarly journals Polyphenols: A Promising Avenue in Therapeutic Solutions for Wound Care

2021 ◽  
Vol 11 (3) ◽  
pp. 1230
Author(s):  
Inês Guimarães ◽  
Sara Baptista-Silva ◽  
Manuela Pintado ◽  
Ana L. Oliveira
Keyword(s):  
Antimicrobial Agents ◽  
Chronic Wounds ◽  
Wound Care ◽  
Release Kinetics ◽  
Wound Dressings ◽  
Wound Site ◽  
Biological Potential ◽  
Efficient Alternative ◽  
Biological Performance ◽  
Complex Wounds

In chronic wounds, the regeneration process is compromised, which brings complexity to the therapeutic approaches that need to be adopted, while representing an enormous loss in the patients’ quality of life with consequent economical costs. Chronic wounds are highly prone to infection, which can ultimately lead to septicemia and morbidity. Classic therapies are increasing antibiotic resistance, which is becoming a critical problem beyond complex wounds. Therefore, it is essential to study new antimicrobial polymeric systems and compounds that can be effective alternatives to reduce infection, even at lower concentrations. The biological potential of polyphenols allows them to be an efficient alternative to commercial antibiotics, responding to the need to find new options for chronic wound care. Nonetheless, phenolic compounds may have some drawbacks when targeting wound applications, such as low stability and consequent decreased biological performance at the wound site. To overcome these limitations, polymeric-based systems have been developed as carriers of polyphenols for wound healing, improving its stability, controlling the release kinetics, and therefore increasing the performance and effectiveness. This review aims to highlight possible smart and bio-based wound dressings, providing an overview of the biological potential of polyphenolic agents as natural antimicrobial agents and strategies to stabilize and deliver them in the treatment of complex wounds. Polymer-based particulate systems are highlighted here due to their impact as carriers to increase polyphenols bioavailability at the wound site in different types of formulations.

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